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Americans in France: What’s the deal with health insurance?

Americans moving to France often have many questions about the healthcare system in France, what type of cover they need and what they should expect to pay.

A doctor at a hospital talks to a patient who is lying on a bed at a hospital in southern France.
Photo: Nicolas Tucat / AFP

If you’re moving to France to live, it’s likely that you will need a visa and this may come with requirements concerning health cover.

But once you have been living in France for a certain period of time you’re entitled to register within the French system for state healthcare, so it’s really a two-step process regarding your health cover.

If you’re only visiting – whether as a tourist or someone with a visitor visa – the system is different 

Health insurance in France: What are the requirements for visitors and residents?

Importantly, paying for private health insurance does not necessarily give you quicker or better access to medical treatment in France.

Healthcare here is routinely and universally excellent.

The first three months

For most types of visa to stay in France, holders will be required to demonstrate an ability to cover the cost of any healthcare. 

This usually means having some form of private insurance to cover the costs of medical repatriation, and emergency and/or hospital treatment to a minimum amount – usually €30,000 – for the length of any stay.

Obviously, this insurance needs to extend cover to France. It is important to note that an American health insurance card is not proof of adequate coverage.

After three months

Anyone who has lived in France for three months and established residency, is eligible to register within the French state health system. 

For this, you will need a numero de securité sociale and a carte vitale – you can apply for this at the Assurance Maladie website

READ ALSO How to get a carte vitale

Once you are registered in the French system, you can then cancel your private health insurance policy – visas only require that you have health cover, and that can include cover from the French system.

However getting yourself registered can take some time – up to six months is common – so we would suggest you don’t cancel the insurance until you are registered and have your carte vitale, just in case.

How the French system works

The French state health system is an insurance system – it’s known as Assurance maladie (health insurance) – and the basic premise is that for any medical cost  (a doctor’s appointment, a prescription, a medical procedure) you pay upfront and the government then reimburses you with part or all of the cost.

The green-and-yellow credit card-sized card known as a carte vitale is proof that you are registered in the French healthcare system. 

Guard your magic healthcare card well. Photo by DENIS CHARLET / AFP

Its microchip contains details of your rights to health cover, and will be routinely requested by your doctor, pharmacist, dentist etc. 

It guarantees that the State will repay its share of your healthcare costs – which can be anything from 30 percent to 100 percent of the total costs depending on your circumstances.

Once you have paid the health professional, they then swipe your carte vitale and the money goes straight into your bank account within a couple of days – there is no need for you to take further action.


If you’re working in France then you’re paying taxes and in exchange the French state will pay your healthcare costs.

If you’re receiving a pension from another country, then usually the French state will pay your costs but then reclaim them from your home country if there is a bilateral agreement in place.

If you’re not working and have not yet reached pension age, you can register for French healthcare through the PUMa system.

But however your healthcare is paid for, you simply swipe the carte vitale and get the money back in your bank account.

‘Top-up’ health cover

As mentioned above, the state system only reimburses a percentage of your costs.

How much is reimbursed is complicated and depends on the type of appointment, type of medical condition being treated and your personal circumstances (eg if you’re pregnant, on benefits or a war veteran).

For example, a standard visit to your family doctor (médecine traitant) costs €25 and is reimbursed at 70 percent, so you get €16.50 back.

Certain conditions, such as cancer or endometriosis, have 100 percent reimbursement where all your costs are taken care of, while others have a rate of 70 or 80 percent reimbursement.

There are a lot of exceptions however and it’s all quite complicated – full details HERE.

In order to cover the extra bit, 96 percent of French people have ‘top-up’ cover, known as a mutuelle.

This takes care of all the extra costs and depending on the policy also covers things like spectacles, hearing aids and dental prothesis or cosmetic treatments.

The first thing you will notice about a mutuelle is that they are considerably cheaper than US private health insurance.

The average cost is about €40 per month for a single person, rising to about €110 for a family of four. If you are an employee, your employer is legally obliged to pay at least half of the cost of your mutuelle.

READ ALSO What you need to know about a French mutuelle

Private insurance

There is no obligation to be registered in the French state system and you can continue to pay for private health insurance if you want.

It doesn’t really give you much of an advantage, though, as French state healthcare is of a very high standard. If you do decide to do this, you will notice that the costs for medical treatments, drugs etc are a lot lower than you are used to back in the US.

It can be helpful to be registered in the state system so that you will routinely be included in public healthcare campaigns. Once you have your details registered you will then be invited for relevant appointments, for example for pap smears or the flu vaccine, depending on your health needs.

It is possible to be registered in the state system and continue to pay for private health insurance if you want.

Member comments

  1. Thanks for this. But in case we opt to keep the private health insurance after 3 months, what insurance companies are recommended? Are there folks that keep their private insurance for the long term and what companies do they suggest?
    It may be interesting to read this as a topic too. Thx.

  2. We are registered, my husband has received his carte vitale. I have not, but I did get an attestation de droits à l’assurance maladie. Do I have to submit something to get reimbursed as described in this article or will it be automatic?

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7 tips to keep your grocery shopping in France affordable

With rising inflation and cost of living, many people in France are desperate to keep their grocery bill low. Here are a few tips for how to avoid paying too much for food, drink and other everyday items.

7 tips to keep your grocery shopping in France affordable

With inflation ticking upward, we’ve seen prices rise, especially for things like fresh vegetables, meat, pasta and cooking oil. Even though inflation is affecting food prices less than energy prices, buying groceries is still a huge part of every household’s budget, and unfortunately things are set to keep getting more pricey. 

We’ve put together a list of a few ways you can save a few euro at the supermarket:

Figure out if you qualify for any government benefits

First things first, it is worth seeing whether you can qualify for any existing government assistance, like CAF. On top of this, the French government has promised to set up a food voucher of €50 per month for low-income households after the parliamentary elections in June. 

READ MORE: EXPLAINED: How to receive CAF payments in France

Compare store prices

Unfortunately, going to the closest supermarket is not always the most economical solution. If you prioritise grocery stores on the lower end of the price spectrum (and you’re willing to walk a bit further) you can save a lot of money. A helpful tool to find the cheapest store near you is the “Que Choisir” online interactive map (click here) that has listed 4,000 affordable stores in mainland France. 

Discount grocery stores, like Lidl and Aldi, are great options for saving a little extra at checkout. But if you must go to a pricier chain, like Monoprix for instance, try to buy Monoprix brand items – they’re typically a little less expensive than name brand foods.

Plan ahead to make the most out of discounts

If you go online ahead of heading to the grocery store, you can see which items will be discounted (“promotion”). If you cannot find this information online, you can always go to the store and ask for a catalogue of that week’s sales items.

Normally, this is something the cashier should have access to. With these discounts in mind, you can construct more affordable recipes. 

Franprix’s website, the ‘discounts’ page

Also, if you’re looking for cheaper recipes in general, you can always go to blogs and online recipe sites specialised in frugal shopping. If you want to try some French specific sites, you can test out “” or “

When it comes to discounts though, be careful about conditions involved (particularly when it comes to loyalty cards).

Sometimes these promotions promise a lot, but actually getting your money back might not be as simple as slashing a few cents at the checkout – you might need to send the coupon somewhere to get the discount, or wait for points to accumulate on your card.

That being said, you can optimise your discounts using several online sites that allow you to combine your loyalty cards (Fidme, Fidall, and Stocard). Other online coupon sites include Groupon, which allows you to make grouped purchases (therefore cheaper), and Coupon Network and Shopmium, which help you benefit from existing discounts. For cashback plans, you can look to websites such as Shopmium, iGraal, FidMarques and Quoty, which allow you to be reimbursed for a part of your expenses.

Make a list, set a budget… and stick to it

It might seem obvious, but when you go into the store, try to resist temptation. The best way to do this is to keep track (in real time) how much you are spending.

Some stores make this easier by allowing you to carry around a ‘self-scanner,’ this will help you to watch your bill go up as you shop. Another tip for this is to withdraw the exact amount of cash you expect to need for the essentials of your trip – obviously in order to do this, you’ll need to know the base prices of your essential items, so it will require a bit of planning ahead.

Buy (then freeze) soon-to-expire products

A consumer’s best friend and sure-fire way to decrease waste! Items coming up on their use-by-date tend to be discounted, so if you plan to purchase these foods and then immediately freeze them, you can significantly extend their shelf life.

Lots of supermarkets make this easier for you by dedicating entire shelves to “short shelf life” items that, according to Elodie Toustou, the head of the “Money” section of the magazine 60 Millions de consommateurs, opting for these foods will allow you to “pay three to four times less.”

Another great way to do this is to use applications like “Phénix” and “Too Good to Go.” These applications will allow you to set your geographic parameter and then click on food stores, restaurants, and bakeries in your area that are getting rid of “panniers” (sacks) of soon-to-be-expired foods. Lots of times these panniers cost only a couple euros.

The trick here is to plan ahead by arriving at the start of the allotted time (if the boulangerie on your corner is offering “Too Good To Go” bags from 11am to 2pm, try to get there as close to 11am as possible for the best items).

Re-consider markets and farmer’s stores

Contrary to popular belief, buying from farmers’ markets and grocers that sell predominantly local products actually can save you money, particularly if you are buying the seasonally relevant fruits and vegetables. Buying directly from a producer can also allow you to eliminate the margin taken by intermediaries. But be careful, this rule is not true all the time.

One way to benefit from cheaper prices at markets is to arrive as late as possible, when the merchants have started to pack up their products. This might allow you to benefit from lower prices or even free items, as they’ll be hoping to get rid of their remaining items.

Know what items are most impacted by inflation

Finally, as inflation continues to increase, try your best to monitor which foods are most impacted. If possible, it might be worth removing or limiting them from your diet – or looking for more affordable alternatives.